Preventing Hospital-Acquired Venous Thromboembolism

Figure 4 is identical to Figure 2, with two additional boxes added. A box with the words "intermediate outcome: is the patient on appropriate VTE prophylaxis here?" appears in the third column and has left-pointing arrows that point to the areas above boxes containing the words "clinical support services deliver appropriate VTE prophylaxis," "change in patient's VTE risk level, contraindications, or site/unit of care," and "no VTE at discharge" and "hospital-acquired VTE." This box and the arrows show that the question of if the patient is on appropriate VTE prophylaxis should be asked at admission, repeatedly during the stay, and at discharge.

Figure 4 also has another box in column three with the words "clinical endpoint: has the patient developed hospital-acquired VTE here?" This box has a left pointing arrow that points to the discharge outcomes of whether the patient either has a hospital-acquired VTE or no VTE at discharge.

To repeat the information Figure 2: This is a conceptual flow diagram of care delivery for providing VTE prophylaxis. It shows the number of interrelated steps that combine to determine whether a patient, at any given moment, is receiving appropriate VTE prophylaxis.

There are four columns of boxes in the diagram. Each box in the second column has downward-pointing arrows, showing the progression of events.

The boxes on the first, or far left, column contain the words "admission," "regular inpatient evaluation," and "discharge" to denote the normal sequence of events associated with a hospital stay.

To the right of the admission box are two stacked boxes in the second column that contain the words "patient admitted to hospital" and "provider orders appropriate VTE prophylaxis at admission." The first box has an arrow pointing to the second, denoting the order in which these events occur. A box that says "provider links patient's VTE risk level to menu of appropriate VTE prophylaxis options" is to the right of the second stacked box, in the third column, and has an arrow pointing to the left. This box denotes the care delivery that can prevent hospital acquired VTE. In the fourth column is a box containing the words "provider performs VTE risk assessment."

Two stacked boxes in the second column appear at the right of the regular inpatient evaluation box. The top box contains the words "clinical support services deliver appropriate VTE prophylaxis." This box has a downward pointing arrow above it to show that the flow of prophylaxis continues from admission. To the right of the box is a left-pointing arrow and a box that contains the words "clinical support services assess patient."

The second box in the stack in the second column features the words "change in patient's VTE risk level, contraindications, or site/unit of care." This box also has a downward pointing arrow above it to denote the flow of events. To the right of this box is one that contains the words "is the patient on appropriate VTE prophylaxis here?" with arrows pointing to admission, regular inpatient evaluation, and discharge to demonstrate that this is a question that should be asked at multiple junctures of a patient's stay.

Finally, two stacked boxes in the second column appear at the right of the discharge box. These contain the words "no VTE at discharge" and "hospital-acquired VTE."